Tough Choices for Mesothelioma Patients and Surgical Options

For families facing malignant pleural mesothelioma (MPM), each decision is difficult. What can we do to ensure the comfort of our loved one? Where should we go to get the best medical consultations or legal advice? Should we think about the full round of treatments or stay more conservative? Those of us at Mesothelioma Circle have spent almost 40 years helping families make these tough but informed choices.

Whether to pursue surgery for mesothelioma is one of the more difficult decisions patients and families have to make. Some doctors are adamant that radical operations will not cure the disease, while others emphasize that such procedures do provide pain relief and may extend survival time.

For those weighing the idea of surgery for MPM, we offer a quick summary of some of the arguments for and against. This is by no means a complete list. To make a fully informed decision, talk with your oncologist and/or surgical specialist before making any decisions.

How surgery can help mesothelioma patients

Most public health agencies agree that, even for a disease as powerful as mesothelioma, surgery has several notable benefits.

1. Surgery can lengthen a loved one’s life by months, if not years. The National Cancer Institute (NCI) estimates that patients who receive surgery for MPM live an average of 16 months beyond their diagnosis.

Survival time depends on several things. First, the earlier a patient’s disease is caught, the longer they may be expected to live. In a study published in the Journal of Thoracic and Cardiovascular Surgery, researchers determined that patients with Stage I or II mesothelioma had much better odds of surviving two, three or even four years, compared to those with Stages III or IV.

The same report noted that pleurectomy/decortication and EPP are the two operations associated with the highest likelihood of prolonged survival

2. Surgery often provides comfort for mesothelioma patients. In fact, the NCI currently categorizes all MPM procedures as palliative, meaning they do not cure the disease but they may ease chest pressure and make breathing easier.

There are a number of operations for MPM, some more extensive than others.

A thoracentesis, in which fluid is drained from the pleura, is one of the simplest and most common procedures.

The pleurectomy/decortication is more radical and involves the removal of one lung and as much tumor mass as possible.

The EPP is the most radical, removing as it does a lung, the lung and heart linings, and most of the diaphragm.

Each surgery may provide pain relief or extend survival.

How surgery can be counterproductive

Unfortunately, not all operations for MPM increase a patient’s lifespan – or, if they do, it may be by a matter of weeks or months only. In the British Journal of Surgery, a pair of surgeons summarized the difficulties by pointing to Lionel Shriver’s memoir of dealing with MPM, titled So Much for That:

She plots the course, from diagnosis to death, of a woman with abdominal mesothelioma in present-day America. Fourteen months after being given a one-year expectation of life, her doctors run out of options and the family runs out of money. The oncologist comforts her bankrupt husband saying “we’ve probably extended her life a good three months.” The bitter irony of “good” strikes the spouse, but seems lost on the doctor.

Such situations are not the standard, but they do happen. It is best to know that while surgery can (and often does) help, it also may not.

Consider whether doctors believe an operation will make your loved one more comfortable. Talk to them, take some time to think about it and, in the end, do what you think is best.

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